Physiological changes in pregnancy

Question 1

Understand how the cardiovascular, respiratory, renal and haematological systems adapt to pregnancy

Understand how these changes may impact on disease and management in pregnancy

List and explain normal values for lab testing where different from the non-pregnant population

Answer 1

.

Question 2

Changes of the breast in pregnancy

Answer 2

Increased size and vascularity (warm + tender)

Increased pigmentation of areola and nipple

Question 3

What is colostrum and when does it first appear

Answer 3

First milk containing special antibodies

Expressed from end of 3rd month

Question 4

How does the cardio system change with pregnancy (most significant changes in 1st trimester)

Answer 4

Increased blood volume

Fall in systemic vascular resistance

Increased cardiac output –> increased stroke volume –> increased HR

Question 5

In supine position, what happens to cardiac output

Answer 5

Reduced by 25%

Question 6

Why can’t you do CPR on a pregnant woman in supine position

+ what position should it be done in

Answer 6

Because cardiac output is reduced when supine in a pregnant lady so not enough blood will return

Left lateral tilt

Question 7

How does cardiac output change during labour and post-delivery

Answer 7

Increases by 10% during labour and by 80% post delivery

Question 8

What are the cardio changes postpartum (returns to normal by 3 months)

Answer 8

Blood volume decreases 3 days post-delivery

BP initially falls but then increases again

Systemic vascular resistance increases

HR returns to normal over 2 wks

CO gradually falls after increasing by 80% 1 hr post delivery

Question 9

What are the resp changes in pregnancy

Answer 9

Increase in oxygen demand

Increase in minute ventilation (essentially hyperventilate) –> increased RR

Increased tidal volume

Decreased functional residual capacity

Question 10

What are the renal changes in pregnancy

Answer 10

Dilation of the tubules + ureters

Increased renal plasma flow

GFR increase –> creatinine clearance increases

Portein excretion increased

Glycosuria

Decreased blood urea and creatinine

Question 11

What are the haematological changes in pregnancy

Answer 11

Plasma volume increases so –> decreased haemoglobin/haematocrit/RCC/platelet count as diluted

Increased need for iron

Increased need in folate (folic acid)

WCC increases

Hypercoaguable

Question 12

Biggest cause of mortality in pregnancy

Answer 12

PE - because increased clotting factors

Question 13

Do the following increase or decrease

• Hb
• WCC
• platelets
• CRP
• ESR

Answer 13

Decrease
Increase
Decrease/same
Same
Increase

Question 14

Do the following increase or decrease

• Urea
• Creatinine
• Urate (uric acid)

Answer 14

Decrease
Decrease
Decrease but increases with gestation

Question 15

Do the following increase or decrease

• 24hr protein
• Total protein
• albumin

Answer 15

Increase
Decrease
Decrease

Question 16

Do the following increase or decrease

• AST/ALT/GGT
• Alk Phos
• Bile acids

Answer 16

Decrease/same
Increase
Same

Question 17

In diabetic pregnant woman, would you want lower or higher blood glucose levels

Answer 17

Lower because you are more insulin resistant when pregnant